| Entity Name: | SOUTHSIDE DERMATOLOGY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 16 Jul 2001 (24 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 02 Apr 2009 (16 years ago) |
| Document Number: | P01000070939 |
| FEI/EIN Number | 522236177 |
| Address: | 4727 SUNBEAM ROAD, JACKSONVILLE, FL, 32257, US |
| Mail Address: | 1807 3RD STREET NORTH, JACKSONVILLE BEACH, FL, 32250, US |
| ZIP code: | 32257 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023276607 | 2008-05-29 | 2014-07-02 | 4727 SUNBEAM RD, SUITE 101, JACKSONVILLE, FL, 322576107, US | 4727 SUNBEAM RD, SUITE 101, JACKSONVILLE, FL, 322576107, US | |||||||||||||||||||
|
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| Phone | +1 904-880-0622 |
| Fax | 9048800623 |
Authorized person
| Name | DR. MARY TRINH PENTEL |
| Role | PRESIDENT |
| Phone | 9048800622 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME16473 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PENTEL DAVID | Agent | 1807 3RD STREET NORTH, JACKSONVILLE BEACH, FL, 32250 |
| Name | Role | Address |
|---|---|---|
| PENTEL MARY T | President | 1807 3RD STREET NORTH, JACKSONVILLE BEACH, FL, 32250 |
| Name | Role | Address |
|---|---|---|
| PENTEL DAVID S | Vice President | 1807 3RD STREET NORTH, JACKSONVILLE BEACH, FL, 32250 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-13 | 1807 3RD STREET NORTH, JACKSONVILLE BEACH, FL 32250 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-13 | 4727 SUNBEAM ROAD, JACKSONVILLE, FL 32257 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-01-18 | 4727 SUNBEAM ROAD, JACKSONVILLE, FL 32257 | No data |
| REINSTATEMENT | 2009-04-02 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| CANCEL ADM DISS/REV | 2004-10-20 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2004-10-01 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J18000708271 | TERMINATED | 1000000799910 | DUVAL | 2018-10-08 | 2038-10-24 | $ 24,761.01 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1415 W US HIGHWAY 90 STE 115, LAKE CITY FL320556156 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-13 |
| ANNUAL REPORT | 2023-07-16 |
| ANNUAL REPORT | 2022-01-27 |
| ANNUAL REPORT | 2021-03-14 |
| ANNUAL REPORT | 2020-03-17 |
| ANNUAL REPORT | 2019-04-02 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-01-12 |
| ANNUAL REPORT | 2016-01-18 |
| ANNUAL REPORT | 2015-02-24 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
